title: Predictors of postoperative atrial fibrillation in patients with coronary artery disease undergoing cardiopulmonary bypass: a possible role for myocardial ischemia and atrial inflammation.
abstract: OBJECTIVE
  To evaluate the preoperative presence of C-reactive protein (CRP) and troponin T(hs-TnT) in patients with coronary artery disease (CAD) undergoing cardiopulmonary bypass (CPB) in order to better clarify the role of atrial inflammation and/or myocardial ischemia in the development of postoperative atrial fibrillation (POAF).
  
  
  METHODS
  Prospective, nonrandomized study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Thirty-eight consecutive ischemic patients admitted to the authors' hospital for CAD undergoing elective on-pump coronary artery bypass grafting (CABG).
  
  
  METHODS
  Elective on-pump CABG.
  
  
  RESULTS
  Peripheral blood samples were collected from all patients before and 24 hours after CABG to assess high sensitive (hs)-CRP and troponin T (hs-TnT) levels. The patients' heart rhythm was monitored by continuous ECG telemetry. Biopsies from the right atrial appendage were obtained at the beginning of the CABG procedure in order to perform immunohistochemistry for CRP and reverse transcription polymerase chain reaction for CRP mRNA expression. Fourteen patients out of 38 (36%) developed POAF. Atrial CRP was found in 31 patients (82%), 10 with POAF and 21 with sinus rhythm (71% v 87% respectively, p = ns). None of the atrial samples was positive for CRP mRNA. Atrial CRP did not correlate with serum hs-CRP levels and with occurrence of POAF, but with the incidence of diabetes (p = 0.010). Postoperative hs-TnT levels, but not hs-CRP levels, were identified as the only predictor of POAF occurrence (p = 0.016).
  
  
  CONCLUSIONS
  In patients undergoing CABG, neither peripheral nor tissue preoperative CRP levels, but only postoperative hs-TnT levels, correlated with POAF, suggesting the primary role of an ischemic trigger of atrial fibrillation.
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy. Electronic address: lianarducci@yahoo.it.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Narducci
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rio
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Leo
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Monaco
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musaico
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pazzano
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Trotta
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Liuzzo
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Severino
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Luigi Marzio
authors.initials: LM
authors.lastname: Biasucci
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Scapigliati
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Glieca
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Cavaliere
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Antonio Giuseppe
authors.initials: AG
authors.lastname: Rebuzzi
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
authors.affiliation: Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000150:complications*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D009205:Myocarditis / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005340:Fibrinogen; D002097:C-Reactive Protein
keywords: atrial fibrillation; coronary artery bypass grafts; immunochemistry; inflammatory mediators; myocardial ischemia